Obstructive sleep apnea (OSA) is a common disease with major cardiovascular and neurocognitive consequences and yet current therapies are unacceptable for some patients. While CPAP (continuous positive airway pressure) can be transformative for some patients, adherence to this treatment is highly variable and alternative therapies suffer from incomplete efficacy. We have recently observed evidence of neuromyopathy in OSA using some newly developed sophisticated electrophysiological techniques. These data have corroborated the findings of other groups showing either sensory or motor impairment of upper airway neuromuscular reflexes in OSA. However, we remain unclear whether the observed findings are indeed clinically important. We plan to define the variability in reinnervation (a marker of nerve injury) in OSA compared to matched controls, also trying to identify predictors of this pattern for clinicians to use. We will further assess the importance of these findings by assessing tongue protrusion force and fatigability as well as the potential impact of neuromyopathy on upper airway mechanics during sleep. We will also conduct a pilot clinical trial to assess the impact of muscle training exercises on OSA patients with and without evidence of reinnervation. Ultimately, we hope that our research will help to define new therapeutic targets at least for a subset of OSA patients.